Birth control pills are hormonal contraceptives that contain small amounts of the synthetic hormones progestin and/ or estrogen. These hormones work to inhibit the natural hormones produced during a woman’s menstrual cycle in order to prevent pregnancy from occurring. This inhibition of natural hormones has several effects on a woman’s body, all of which combine together to prevent pregnancy. Hormonal contraceptives usually stop a woman from ovulating and in addition they change the cervical mucus, making it harder for sperm to swim through the cervix and to get to the egg. They can also change the lining of the uterus making it unlikely that the embryo will implant.1
Which pill is right for me?
Choosing the right contraceptive pill can be a bit of a minefield, and it can sometimes take a few attempts to finally find the right pill to suit your body. One of the most common questions when starting the pill is: ‘What type of pill should I take?’ The pill can be divided in two types: the combined pill and the mini-pill (or progestin-only pill). The most popular choice is the combined pill, known simply as ‘the pill’. It combines the two female hormones estrogen and progesterone in the form of a progestin.2,3
The combined pill
The pill is 99% effective, doesn’t interrupt sex, usually makes your period lighter and less painful, reduces your risk of cancer of the ovaries, womb, and colon In addition it may protect against pelvic inflammatory disease, reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.
The pill can cause temporary side effects at first, such as:
- Tender breasts
- Mood swings
If these don’t go after a few months, you need to switch pills
Other possible side effects include:
- Increased blood pressure
- spotting in the first few months
- blood clots (slightly increased risk)
- breast cancer (slightly increasd risk)2
Contrary to popular belief, it’s not a weaker version of the combined pill, it just contains one hormone (progestogen) instead of two. The result is that there are virtually no side-effects, but unfortunately this also means that it’s less effective.
The pros? There’s no break so it’s easier to remember to take it, it’s safe to use when breastfeeding, it’s not affected by using antibacterials and there is no increase in risk of blood clots or other cardiovascular diseases.
The cons? It’s not as effective as the combined pill, with a success rate of between 96 and 99% percent. It can also cause irregular periods or complete cessation of your period, a slightly increased risk of ectopic pregnancy, pimples, tender breasts, a slightly increased risk of cysts on the ovaries, change in body weight, nausea and dizziness.2
When you visit a doctor or nurse to discuss contraception choices they will undertake a medical history discussion with you, including specific questions about you and your family’s medical history as certain medical conditions may affect the pill options available to you, any medication you may be taking, and lifestyle factors e.g. smoking. They will also measure your height, weight and blood pressure. All of this information helps them to see which type of pill or other methods of contraception are likely to be suitable for you.2
Your health care provider may discourage use of combination birth control pills if you:
- Are breast-feeding
- Are older than age 35 and smoke
- Have poorly controlled high blood pressure
- Have a history of or current deep vein thrombosis or pulmonary embolism
- Have a history of breast cancer
- Have a history of stroke or heart disease
- Have diabetes-related complications, such as nephropathy, retinopathy or neuropathy
- Have liver disease
- Have unexplained uterine bleeding
- Will be immobilized for a prolonged period due to major surgery
- Take St. John’s wort, or anticonvulsant or anti-tuberculous agents
Your health care provider may discourage use of the minipill if you:
- Have breast cancer
- Have unexplained uterine bleeding
- Take anticonvulsant or anti-tuberculous agents3
If you’ve never taken the pill before, it is recommended that you start on a brand with a low dose of both estrogen and progestin. In addition, it’s all about getting the hormone balance right, as some estrogen-dominant pills can cause nausea, dizziness, pre-menstrual syndrome (PMS), bloating, breast pain, weight gain and increased vaginal secretions. On the other hand, progestin-dominant pills can lead to vaginal dryness, weight gain, depression, loss of libido, and fatigue. If you experience any of these symptoms, ask your doctor to put you on a pill with a more or less powerful dose of hormones. 2
Certain pills are also said to help with some unwanted symptoms:
Bloating, PMS, tender breasts: An ultra-low dose estrogen pill can help with these symptoms but watch out for breakthrough bleeding. Another option could be a more progestin-dominant pill.
Acne and facial hair growth: Combined pills containing co-cyprindiol, a combination of an estrogen plus cyproterone, can help counter the over-production of testosterone.
Dry vagina, loss of libido: This usually means your pill contains too much or the wrong kind of progestin. Try switching to a pill with a different progestin and also one which is estrogen-dominant.
Water retention and bad PMS: Pills containing drospirenone, a new form of progestin which is said to be closer to your natural hormones, can help.2
How long is it safe to stay on the pill?
There is no medical reason that you need to take a break from the Pill. In fact some women stay on it for 25 years, although some women prefer to have a change once in a while. This can be due to wanting to start a family or personal reasons. It’s a myth that your body needs a break, if you’re happy and there are no health or medical issues there is no need to come off it and you can happily use it through to the menopause.2